Encounter tracker and service gap analysis system and method of use

ABSTRACT

Methods and systems for tracking whether an individual has received required services and for analyzing service gaps. In one embodiment, the present invention tracks special education students to ensure that they receive services that have been designated as appropriate for them. When a service is provided to any student by any provider, this information is input and maintained electronically. Once this information is entered, it can be analyzed to ensure that the services provided correspond with the student&#39;s IEP. In another embodiment, data from the input information on service encounters is usable with Medicaid or other reimbursement services to produce documents for submission for reimbursement.

[0001] This application claims priority from U.S. ProvisionalApplication Serial No. 60/422,869 filed Nov. 1, 2002. The entirety ofthat provisional patent application is incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The present invention relates to a software based method andsystem for tracking and supporting compliance with a management schemefor individualized educational instruction, behavioral interventions orsocial interventions, and in particular to a software based method andsystem for tracking of, supporting compliance with, and otherwiseassisting in determining whether an individual has received requiredservices, analyzing service gaps, and using data provided in suchdeterminations to assist in obtaining Medicaid or other reimbursements.

[0004] 2. Background of the Technology

[0005] There is an unmet need in the art for methods and systems for thetracking of, supporting compliance with, and otherwise providingassistance in meeting requirements for the complex and sophisticatedmanagement schemes that institutions need to use in order to effectivelyand efficiently manage mandated individualized instructional paths,disciplinary/rehabilitative paths, or social intervention paths forhundreds if not thousands of students, juveniles, etc., simultaneously,all with different start and end dates, and different internalindividualized management steps. For example, looking at mandatedindividualized instructional paths, it is not uncommon to find that aU.S. public K-12 school district may need to manage 30% or more of itsstudent population under individualized instructional programs such asSpecial Education, 504, English Second Language, EarlyIntervention/Student Support Team, Gifted and Talented, or At Risk ofFailing High Stakes Exit Exams. Each of these programs includesrequirements involving events or meetings (such as Referrals, or AnnualMeetings or Reevaluation Meetings), associated timeliness linkedpaperwork, and mandated outcomes.

[0006] Successful, consistent, legally compliant execution of theseindividualized programs by a school district requires the tightcoordination of dozens of action steps across multiple team members foreach affected child within relatively short time periods. Failure toeffectively manage, what in many school districts may be thousands ofindividualized instructional paths going on simultaneously,significantly diminishes the education effectiveness of theseinterventions, exposes the district to serious legal liability forviolating Federal and State law, risks loss of full Federal and Statefunding, and drives up a district's administrative overhead.

[0007] An individualized education plan (IEP), as required by theIndividuals with Disabilites Education Act (IDEA), specifies services tobe provided to children with disabilities. School districts or otherentities responsible for carrying out the provisions of the IDEA mustensure that the services specified are actually provided, both forliability reasons under the Act and to obtain reimbursements, asappropriate, such as from Medicaid. However, determining the servicesactually provided by the provider is difficult for several reasons.

[0008] First, many problems can arise in determining the actual numberof services that should be provided in a given time frame, and existingsystems for supporting IDEA activities typically do not adequatelyaddress this issue. For example, the frequency of services is oftendesignated on a monthly or weekly basis. However, these frequencydesignations often cause inconsistencies and confusion, for example, dueto anomalies in calendar periods (e.g., determining how many weeklyservices are to be delivered in a month when a month has four weeks andone day; accounting for vacations, holidays, and other absences) and/ordifficulties in calendars across a school system (e.g., reconcilingservices to be delivered following a child's move from one buildingoperating on a school year calendar to another building operating on anannual calendar).

[0009] Yet another problem with prior art systems is that these systemstypically track only positive encounters (i.e., service encounters thatactually occur). This approach fails to allow the service provider toaccount fully for the service provider's efforts, however, since itfails to account for attempts to provide services for a child. It isimportant to account for the fact that the school district or otherentity's legal obligation to provide services for the child may be metby making the service available for the child at a specified time andplace, even though the child may fail to appear and receive thatservice.

[0010] For example, if a service provider is to provide two therapyencounters or sessions to a child each week, and a four week period istracked, eight therapy sessions over the time period will be received.To identify any gaps in service actually provided, this theoreticaleight sessions must be compared to the sum of both actual sessionsprovided and attempts to provide services. Thus, if six sessions areactually provided, and the provider attempted to provide services on oneoccasion, the actual gap in services should be one session. There is aneed for a system that appropriately accounts for service attempts.

[0011] There is a further need for a system that accounts forresponsibility identification. For example, if a child moves frombuilding A to building B on a particular date, a service provider atbuilding A may no longer be responsible for providing the service, yetbe unaware of the move to the new building; similarly, a new serviceprovider at building B may now be responsible for that child, but beunaware that the child is now present in building B and, likewise,unaware of the new responsibility.

[0012] In particular, existing IEP tracking systems typically track whothe provider is for each child, but when a change in services occurs,the previous provider is simply overwritten. Further, no start or enddate is typically tracked by provider. As a result, no audit trail orother appropriate accountability can be established with the existingsystems.

[0013] With regard to reimbursement, currently, Medicaid recovery forIDEA services is obtained in one of two ways: 1) primarily, recoveryoccurs via paper-based submission for services (e.g., blank forms orforms with only the child's name are forwarded to individual providersto complete); or 2) electronic versions of the paper-based recoverysystem are used (e.g., “palm-pilot” based versions of paper systems).One key problem is lack of accountability: at any given time, schooldistricts or other entities are not able to determine what providershave submitted documents for Medicaid recovery.

[0014] As a result, low recovery of Medicaid cost reimbursement occurswith the prior art for most districts or other entities. In general,this low recovery can be tracked to two key factors: 1) underreporting(e.g., service provider forgets to report, although the service has beenprovided); if the district or other entity is paper-based orsemi-automated, it will never know that the event has occurred and hasnot been reported; every event of underreporting costs the district orother entity Medicaid cost reimbursement; and 2) underservicing (e.g.,service provider should have seen child, but failed—for example, serviceprovider sick; child changed buildings, and service provider was nottold; service provider simply won't see child); underservicing costs thedistrict or other entity Medicaid cost reimbursement, and also creates asevere liability for the district or other entity under state and/orfederal law to provide compensatory damages for the child. The coreissue for underreporting and underservicing is accountability. Thedistrict or other entity needs to know how many services a serviceprovider provided or should have provided to each child.

[0015] There remains an unmet need for methods and systems that accountfor and assist with determining gaps in services required to beprovided, such as services under the IDEA, and to assist withreimbursement of these services.

SUMMARY OF THE INVENTION

[0016] The present invention includes systems and methods for trackingthe services provided to a student or other individual and for analyzingservice gaps, as well as to assist in recovery of costs for suchservices. In one embodiment, the present invention can be used to assistin compliance with the IDEA.

[0017] The present invention is able to interface with other managementsystems, such as systems that provide features for allowing selectionand recordation of the name of the actual provider legally responsiblefor each service delivered to a child at any time under the Individualswith Disabilities Education Act (IDEA). For example, one such managementscheme referred to as the Special Education Tracking System (SETS), alsoprovides for “cloning,” which allows a substitute provider to beidentified for particular child services, but with identicalresponsibilities to those of the previous provider, while removingresponsibility for the replaced provider. A further feature of the SETSsystem is customizable scheduling, which allows the calendar to vary,for example, by building or other location. In addition, the SETS systemprovides an interface for the school district or other entity to trackwhat school each child is registered in at any point in time.

[0018] Another example management system usable with the presentinvention is one or more data repositories (e.g., databases) associatedwith the components, which allow entry and interrelation of data amongthe components, and identification and completion of forms relatingthereto. In one embodiment, the components are directed to activitiesrelating to compliance, tracking, or other functions. In one embodimentrelating to implementation for compliance with the IDEA, the componentsinclude the following: 1) compensatory/violations; 2) school and codesinformation; 3) event/meeting timelines and outcomes, planning and otherinformation; 4) IEP tracking and information maintenance; 5) disciplineinformation; and 6) student master information.

[0019] In conjunction with these management systems, in an embodiment ofthe present invention, a service plan is used that describes theservices that are expected to be provided to an individual. In oneembodiment, the individual is a student, and the service plan is an IEPthat describes services to be provided to the student under the IDEA.

[0020] In one embodiment, encounters, or services provided, attempted,or missed, are input into a system and stored. The encounter informationinput into the system includes, for example, the service provider, theindividual receiving the service, the procedure code, or type of service(such as, for example, family counseling, occupational therapyevaluation, or physical therapy treatment), the school or district, theduration of the encounter, the encounter type (such as, for example, theservice provider worked with the student and teacher, the encounter wasmissed because the student was absent, the encounter was missed becausethe service provider was attending another meeting), and the result ofthe encounter (for example, the student met the goal, treatment shouldbe continued, treatment should be modified, the student refused to worktoward the goal).

[0021] The encounter information in the system can then be compared tothe expected services described in the service plan. The results of thiscomparison are used, for example, to generate a service gap analysisreport, which calculates the shortfall or excess of services provided.Service gap analysis reports may be generated to find a shortfall orexcess of services provided within a given period for a particularstudent, a particular service provider, a particular school or district,a particular individual education plan, or some combination thereof. Inone embodiment, the shortfall or excess is reported in hours andfractions of hours.

[0022] The encounter information in the system can also be used inconjunction with reimbursement functions. For example, encounterinformation can be used to automatically generate a bill, which isoptionally electronically transmitted to a reimbursement entity, such asa state government office.

[0023] Additional advantages and novel features of the invention will beset forth in part in the description that follows, and in part willbecome more apparent to those skilled in the art upon examination of thefollowing or upon learning by practice of the invention.

BRIEF DESCRIPTION OF THE FIGURES

[0024] In the figures:

[0025]FIG. 1 presents an exemplary system diagram of various hardwarecomponents and other features in accordance with an embodiment of thepresent invention;

[0026]FIG. 2 is a block diagram of various system components, inaccordance with an embodiment of the present invention;

[0027]FIG. 3 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0028]FIG. 4 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0029]FIG. 5 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0030]FIG. 6 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0031]FIG. 7 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0032]FIG. 8 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0033]FIG. 9 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0034]FIG. 10 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0035]FIG. 11 is a flow diagram illustrating data flow for encountertracker functions, in accordance with an embodiment of the presentinvention;

[0036]FIG. 12 is a flow diagram illustrating data flow for encountertracker functions, in accordance with an embodiment of the presentinvention;

[0037]FIG. 13 is a flow diagram illustrating data flow for encountertracker functions, in accordance with an embodiment of the presentinvention;

[0038]FIG. 14 is an example Graphical User Interface (GUI) screen shotfor encounter tracker functions, in accordance with an embodiment of thepresent invention;

[0039]FIG. 15 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0040]FIG. 16 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0041]FIG. 17 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0042] FIGS. 18 A-B are example GUI screen shots for encounter trackerfunctions, in accordance with an embodiment of the present invention;

[0043]FIG. 19 is a flow diagram illustrating a process for service gapanalysis, in accordance with an embodiment of the present invention;

[0044]FIG. 20 illustrates a system for service gap analysis, inaccordance with an embodiment of the present invention.

[0045]FIG. 21 is an example GUI screen shot for service gap analysis, inaccordance with an embodiment of the present invention;

[0046]FIG. 22 is an example GUI screen shot for service gap analysis, inaccordance with an embodiment of the present invention;

[0047]FIG. 23 is an example GUI screen shot service gap analysis, inaccordance with an embodiment of the present invention.

DETAILED DESCRIPTION

[0048] The present invention provides a system and method for trackingwhether an individual has received required services and for analyzingservice gaps, as well as assisting with reimbursements relating thereto.In one exemplary embodiment, the present invention tracks specialeducation students to ensure that they receive services that have beendesignated as appropriate for them. In an embodiment of the presentinvention, a service plan, such as, for example, an IEP, describes theservices that are expected to be provided to an individual, such as astudent. The service plan contains one or more service details. Eachservice detail describes, for example, a service that is expected to beprovided, the service provider responsible for providing the service,and the duration and frequency of the expected service. For example, aservice detail, such as an IEP detail, specifies that service providerMary Smith is responsible for providing physical therapy sessions twicea week, each session lasting 30 minutes. If the service plan is an IEP,the service details contained in the service plan are referred to as IEPdetails. Other types of service details and other types of service plansexist and are usable in conjunction with the present invention.

[0049] In one embodiment of the present invention, when a service isattempted or provided to any individual by any provider, or when aservice is missed, this information is input into a system andmaintained electronically. The input information is referred tointerchangeably as an encounter or a session. Once the information isentered, it can be analyzed to ensure that the services providedcorrespond with the IEP or other service plan, and gaps in services canbe determined, such as by use of the service gap analysis feature, alongwith information from other systems and methods. The system alsoprovides functionality to export encounter information for billingpurposes.

[0050] Various features of the present invention are disclosed in orinteract with one or more features of applicant's following copendingprovisional and utility patent applications: U.S. patent applicationSer. No. 10/406,246 filed Apr. 4, 2003, titled “Method and System forOnline Analytical Processing for Educational and Other Outcomes”; U.S.patent application Ser. No. 10/628,790 filed Aug. 27, 2003, titled“Method and System for Compliance Forms and Compliance Forms UserInterface”; and U.S. Patent Application Serial No. 60/477,346 filed Jun.11, 2003, titled “Management Tracking and Forms System and Method ofUse.” The entirety of each of these patent applications is incorporatedherein by reference.

[0051] SETS System Interface

[0052] The present invention includes multiple levels of functionalitythat address the issue of accountability, for both underreporting andunderservicing. In one embodiment, the present invention interacts withthe invention that is the subject of applicant's copending U.S. patentapplication Ser. No. 10/455,804 filed Jun. 6, 2003, titled “SpecialEducation Tracking System and Method of Use” (also interchangeablyreferred to as Special Education Tracking System and referred tohereinafter “SETS system” ), which is hereby incorporated by reference.To assist with compliance with the IDEA, the SETS system includestracking of services provided within IEPs. The SETS system includesfeatures that allow recordation of the name of the actual providerlegally responsible for each service delivered to a child at any timeunder the IDEA.

[0053] In particular, the IEP records within the SETS system includethree tiers of information. The third tier of the SETS process includesan option to select a provider automatically for each child, such as bylinking a provider to the child via the building in which the child andthe provider are located. Thus, a responsible provider is automaticallyselected and in place at all times for each child, based, for example,on the child's location. If the option to select a providerautomatically for each child is not chosen by the particular schooldistrict or other entity (e.g., the district or other entity chooses tolink the child to the provider manually), the SETS system provides fordistrict or other entity manual selection of a provider for each childand each service. In both the automated and the manual modes, the SETSsystem thus ensures that a particular provider is identified at alltimes for each child service provided.

[0054] Another feature of the SETS system that is relevant to thepresent invention is referred to as “cloning,” which allows a substituteprovider to be identified for particular child services, but withidentical responsibilities to those of the previous provider, whileremoving responsibility for the replaced provider. Thus, for example,when a provider must be absent (e.g., on sick leave), a clonedreplacement provider can be identified under the SETS system to beresponsible for the same services as the absent provider (rather than,for example, either not recording the substitution or manuallysubstituting during the absence and then again upon return of thedesignated provider). As a result, this feature ensures that aparticular provider is identifiable at all times for each child service,regardless of the presence or absence of any one particular provider inthe system.

[0055] Yet another unique feature of the SETS system that is ofimportance to the present invention is customizable scheduling, whichallows the calendar to vary, for example, by building or other location.A critical component of many school districts or other entities isvariation in schedule by building (e.g., school year versus calendaryear, depending on building). Because of this feature of the SETSsystem, a theoretical calculation can be made of the level of servicesthat should be provided to each child by each provider, based, forexample, on the amount of time that the child is scheduled to be in eachbuilding and the amount of services the child is scheduled to receiveunder that child's IEP. For example, if a child is to receive a certaintype of therapy twice a week, and the child is determined to be locatedin a particular building and having a particular service provider forthat therapy, over a four week period the child should theoreticallyreceive eight units of the therapy by the identified service provider inthat building.

[0056] The SETS system also provides an interface for the schooldistrict or other entity to track the school in which each child isregistered at any point in time. One reason that maintenance of thisinformation is significant is because service providers are often nottold that a child has left the system or is no longer present forservices in the building in which the service provider is located.Absent this feature of the SETS system, a great deal of time may passbefore the service provider becomes aware of the provider's change inresponsibilities toward the child who has left the system or building,while identification of a new provider for that child may similarly bedelayed. Regardless of these difficulties, however, the district orother entity is responsible for ensuring that continuous services areprovided to each child. The tracking interface of the SETS systemprovides a tool for meeting this responsibility.

[0057] Encore System Interface

[0058] The present invention includes multiple levels of functionalitythat address the issue of accountability, for both underreporting andunderservicing. In one embodiment, the present invention interacts withthe invention that is the subject of applicant's copending provisionalU.S. Patent Application Serial No. 60/477,346 filed Jun. 11, 2003,titled “Management Tracking and Forms System and Method of Use,” alsoreferred to herein interchangeably as the “Encore system.” The Encoresystem includes a database structure and platform, as well as a codeauthoring tool, referred to in one embodiment as a “workbench,” forassisting users with developing code in an automated fashion for usewith the database structure and platform.

[0059] The Encore system provides one or more data repositories (e.g.,databases) associated with the components, which allow entry andinterrelation of data among the components, and identification andcompletion of forms relating thereto. In one embodiment, the componentsare directed to activities relating to compliance, tracking, or otherfunctions. In one embodiment relating to implementation for compliancewith the IDEA, the components include the following: 1)compensatory/violations; 2) school and codes information; 3)event/meeting timelines and outcomes, planning and other information; 4)IEP tracking and information maintenance; 5) discipline information; and6) student master information.

[0060] One embodiment of the Encore system further provides a method andsystem for rapidly tailoring or customizing compliance requirements andother functions for each management entity. The Encore system provides adatabase structure and platform for rapidly configuring/customizing thedatabase structure to mirror the school district's or county's orstate's agreed upon business process surrounding meeting/events,timelines, outcomes, and associated paperwork.

[0061] For example, the Encore system allows the management method andsystem to be initially tailorable/configurable to the requirements of aparticular school district or other management entity maintaininginformation. Tailoring includes determining a management entity's dataoptions and rules, appropriately identifying any corresponding dataoptions and rules in a master repository linking the corresponding dataoptions and rules, and adding, as necessary, each data option and ruleof the management entity's particular scheme for implementation. Thetailored system is then used to assist with compliance and tracking ofinformation for the customized management scheme.

[0062] In embodiments of the Encore system, the user is able to selectto have a compliance check performed on forms in the system to determinethe status of the forms. The Encore system evaluates informationcompleted and missing, or that is incomplete, for each form, and formsfor which outstanding items remain to be completed fail the compliancecheck.

[0063] Encounter Tracking Feature

[0064] The SETS and Encore systems, for example, thus provide atheoretical basis of information for use by the present invention inperforming gap analysis of services to be provided to each child, versusservices actually delivered by each service provider. One feature of thepresent invention, referred to in one embodiment as “Encounter Tracker,”provides functions for inputting information on actual services providedand attempted provision of services, as a second necessary component,along with the SETS or Encore system information, to perform such gapanalysis. Another purpose of this encounter tracking feature is toprovide to each service provider an accessible list of children or othertracked individuals for whom the service provider is legally accountablefor providing specified services. This feature thus provides the serviceprovider with a real-time caseload of services and serviced individuals.

[0065] Thus, for example, when a child changes buildings, this change inservices for both the provider formerly servicing the child and a newlyidentified provider who will continue servicing the child is immediatelyhighlighted for each service provider. In one embodiment of the presentinvention, new additions to the service provider workload are furtherhighlighted by appearing in a special color, such as red, within thesystem.

[0066] These features of the present invention therefore allow theschool district or other entity to become more efficient in terms ofidentifying and linking children to specific service providers at alltimes, and also help districts or other entities to ensure compliancewith corresponding legal requirements relating to services that must beprovided to each child.

[0067] Another advantage of the present invention is that it allows eachservice provider to identify at any time, via accessing of the system(e.g., online for network based variations), each child for whom theservice provider has actually provided services. In an embodiment of thepresent invention, the input of actual services provided is referencedagainst the caseload for the service provider. In an embodiment of thepresent invention, GUI allows the service provider to select a childfrom a list of children for whom the service provider provides services,so that a list of scheduled services to be provided, along with thosethat have actually been provided can be immediately identified andreviewed by the service provider.

[0068] In an embodiment of the present invention, all information inputand viewed by the service provider to the system is code driven (e.g.,input and viewed by diagnostic code, intervention code), allowing theservice provider to report an encounter fully using only a fewkeystrokes (i.e., minimizing data entry time). Valid codes and codecombinations are tailored to the state plan. In addition, the serviceprovider is able to select to automatically default the data in thereport to that contained in the previous report or in the profile forthe child, allowing even further reduction in effort to prepare eachreport.

[0069] Service Gap Analysis Feature

[0070] An embodiment of the present invention allows the serviceprovider to periodically (e.g., monthly) run a service gap analysisreport based on the SETS or Encore system information and the encountertracking feature information. The report can include both negative gaps,showing shortfalls, and positive gaps, showing services greater than theexpected number, along with combined totals over longer or combinedperiods (e.g., a short week or month may indicate a partial service isto be provided, which may occur during that time period or in thesubsequent time period, producing either a positive over service or anegative gap, respectively, for that time period, which collectivelybalance out).

[0071] In an embodiment of the present invention, information from eachmonth or other selected time period is analyzed to determine any gap inthe amount of services delivered during that month. These services aredefined as the combined number of actual delivered services and servicesthat were attempted to be delivered. In addition, surpluses and deficitsfrom succeeding periods are added together to provide an overall deficitor surplus that a provider for a child has for a given period of time.

[0072] An embodiment of the present invention also includes an optionfor the service provider to correct any reporting errors within thereport produced (e.g., a service provider can correct an accidentalfailure to include a service provided), providing that the encounter hasnot been exported for billing.

[0073] As a further check within an internal audit process of anembodiment of the present invention, for use, for example, with IDEArequirements, input information on services provided or attempted iscompared to attendance records for each child (e.g., the school'sattendance record for the child is checked against each date that theservice provider indicates that services were provided, in order toensure that the child was actually present in the building the day theservices were supposedly provided). Similarly, records as to actualpresence of the service provider at the school can be compared toservice provision information as a further audit of service providerinput.

[0074] Service Gap Analysis OLAP Feature

[0075] Another feature of the present invention relates to interactionwith features of the invention that is the subject of applicant'scopending U.S. patent application Ser. No. 10/406,246, filed Apr. 4,2003, titled “Method and System for Online Analytical Processing forEducational and Other Outcomes” (hereinafter “OLAP system” ). Anembodiment of the OLAP system includes a selected set of interrelatedareas or fields, referred to as a “cube,” relating to data for thepresent invention. This OLAP system cube allows overview analysis ofinformation obtained from the present invention, such as identificationof providers having missed encounters greater than a predeterminedthreshold (e.g., more than two missed sessions over a given timeperiod). The school district or other entity can thus quickly identifyproblems with service providers or otherwise with regard to failedprovision of services, and thus also manage, for example, reimbursementand legal compliance risk. One benefit of the service gap analysisfeature of the present invention is that it identifies shortfalls andprovides information about the shortfalls.

[0076] In an embodiment of the present invention, the data from theservice provider input information on service encounters is usable withMedicaid or other reimbursement services to produce documents forsubmission for reimbursement.

[0077] References will now be made in detail to an embodiment of thepresent invention, an example of which is illustrated in theaccompanying drawings.

[0078] As shown in FIG. 1, in an embodiment of the present invention,data for use in the system is, for example, obtained by a user 1 via aterminal 2, such as a personal computer (PC), minicomputer, mainframecomputer, microcomputer, telephonic device, or wireless device, such asa hand-held wireless device coupled to a server 3, such as a PC,minicomputer, mainframe computer, microcomputer, or other device havinga processor and a repository for data or connection to a repository fordata, via a network 4, such as the Internet or an intranet, andcouplings 5, 6. The couplings 5, 6 include, for example, wired,wireless, or fiberoptic links. In another embodiment, the method andsystem of the present invention operate in a stand-alone environment,such as on a single terminal.

[0079] The present invention may be implemented using hardware, softwareor a combination thereof and may be implemented in one or more computersystems or other processing systems. In one embodiment, the invention isdirected toward one or more computer systems capable of carrying out thefunctionality described herein. An example of such a computer system 20is shown in FIG. 2.

[0080] Computer system 20 includes one or more processors, such asprocessor 24. The processor 24 is connected to a communicationinfrastructure 26 (e.g., a communications bus, cross-over bar, ornetwork). Various software embodiments are described in terms of thisexemplary computer system. After reading this description, it willbecome apparent to a person skilled in the relevant art(s) how toimplement the invention using other computer systems and/orarchitectures.

[0081] Computer system 20 can include a display interface 22 thatforwards graphics, text, and other data from the communicationinfrastructure 26 (or from a frame buffer not shown) for display on thedisplay unit 23. Computer system 20 also includes a main memory 28,preferably random access memory (RAM), and may also include a secondarymemory 21. The secondary memory 21 may include, for example, a hard diskdrive 25 and/or a removable storage drive 27, representing a floppy diskdrive, a magnetic tape drive, an optical disk drive, etc. The removablestorage drive 27 reads from and/or writes to a removable storage unit 29in a well known manner. Removable storage unit 29, represents a floppydisk, magnetic tape, optical disk, etc., which is read by and written toremovable storage drive 27. As will be appreciated, the removablestorage unit 29 includes a computer usable storage medium having storedtherein computer software and/or data.

[0082] In alternative embodiments, secondary memory 21 may include othersimilar devices for allowing computer programs or other instructions tobe loaded into computer system 20. Such devices may include, forexample, a removable storage unit 30 and an interface 31. Examples ofsuch may include a program cartridge and cartridge interface (such asthat found in video game devices), a removable memory chip (such as anerasable programmable read only memory (EPROM), or programmable readonly memory (PROM)) and associated socket, and other removable storageunits 30 and interfaces 31, which allow software and data to betransferred from the removable storage unit 30 to computer system 20.

[0083] Computer system 20 may also include a communications interface32. Communications interface 32 allows software and data to betransferred between computer system 20 and external devices. Examples ofcommunications interface 32 may include a modem, a network interface(such as an Ethernet card), a communications port, a Personal ComputerMemory Card International Association (PCMCIA) slot and card, etc.Software and data transferred via communications interface 32 are in theform of signals 33, which may be electronic, electromagnetic, optical orother signals capable of being received by communications interface 32.These signals 33 are provided to communications interface 32 via acommunications path (e.g., channel) 34. This path 34 carries signals 33and may be implemented using wire or cable, fiber optics, a telephoneline, a cellular link, a radio frequency (RF) link and/or othercommunications channels. In this document, the terms “computer programmedium” and “computer usable medium” are used to refer generally tomedia such as a removable storage drive 27, a hard disk installed inhard disk drive 25, and signals 33. These computer program productsprovide software to the computer system 20. The invention is directed tosuch computer program products.

[0084] Computer programs (also referred to as computer control logic)are stored in main memory 28 and/or secondary memory 21. Computerprograms may also be received via communications interface 32. Suchcomputer programs, when executed, enable the computer system 20 toperform the features of the present invention, as discussed herein. Inparticular, the computer programs, when executed, enable the processor24 to perform the features of the present invention. Accordingly, suchcomputer programs represent controllers of the computer system 20.

[0085] In an embodiment where the invention is implemented usingsoftware, the software may be stored in a computer program product andloaded into computer system 20 using removable storage drive 27, harddrive 25, or communications interface 32. The control logic (software),when executed by the processor 24, causes the processor 24 to performthe functions of the invention as described herein. In anotherembodiment, the invention is implemented primarily in hardware using,for example, hardware components, such as application specificintegrated circuits (ASICs). Implementation of the hardware statemachine so as to perform the functions described herein will be apparentto persons skilled in the relevant art(s).

[0086] In yet another embodiment, the invention is implemented using acombination of both hardware and software.

[0087] FIGS. 3-10 illustrate sample GUI screens that are displayed to auser when a user enters a new encounter into the system.

[0088]FIG. 3 is an example GUI screen shot that lists information forone or more students. The user selects “Encounters” to activate theencounter tracking functionality.

[0089]FIG. 4 is an example GUI screen shot that is displayed after auser selects “Encounters” from the GUI of FIG. 3. The user selects“Search” to select and search through students serviced. FIG. 4 alsoincludes a “Not in SETS” button that a user may select to enterencounter information for a student who is not entered into the system,or to otherwise enter encounter information that the system would not beable to store. In one embodiment, the information stored after a userselects “Not in SETS” is stored separately from the other encounterinformation, and requires user followup to determine further action.

[0090]FIG. 5 is an example GUI screen that is displayed after a userselects “Search” from the GUI of FIG. 4. The user enters one or moresearch criteria, such as, for example, school type, school name, serviceprovider, or IEP service. The user may enter these search criteria, forexample, by typing in a field or by selecting from a pull-down menu. Theuser then selects “Search” to activate the search functionality.

[0091]FIG. 6 is an example GUI screen that is displayed after a userenters one or more search criteria and selects “Search” from the GUI ofFIG. 5. The user selects “Encounter Detail” to activate the encounterinput functionality. The application can be configured to enablesearching, or to display those children assigned to a certain provider,depending, for example, on the user.

[0092] FIGS. 7-10 are example GUI screen shots for encounter trackerfunctions, in accordance with an embodiment of the present invention.The screen shot of FIG. 7 is displayed, for example, after a userselects “Encounter Detail” from the GUI of FIG. 6. The user verifies theIEP information. In one embodiment of the present invention, the IEPmust be valid for the date of the encounter and the system will notpermit a user to enter an encounter for an expired or otherwise invalidIEP. The user enters information relating to the encounter or servicethat was provided, attempted, or missed. The information entered by theuser includes, for example, information relating to the serviceprovider, or information relating to the procedure code, or type ofservice (such as, for example, family counseling, occupational therapyevaluation, or physical therapy treatment), as shown in FIG. 8. Theinformation entered by the user also includes, for example, theencounter type (such as, for example, the service provider worked withthe student and teacher, the encounter was missed because the studentwas absent, the encounter was missed because the service provider wasattending another meeting), as shown in FIG. 9. The information enteredby the user also includes, for example, the result of the encounter (forexample, the student met the goal, treatment should be continued,treatment should be modified, the student refused to work toward thegoal), as shown in FIG. 10. The user may enter the encounterinformation, for example, by typing in a field or by selecting from apull-down menu. Information also includes, for example, the duration ofthe encounter.

[0093]FIG. 11 is a flow diagram illustrating data flow for encountertracker reporting and gap analysis functions, in accordance with anembodiment of the present invention. FIG. 11 illustrates one possibleimplementation of a method to extract encounter data. The method of FIG.11 can be implemented, for example, as one or more Structured QueryLanguage (SQL) queries made to a database. Other implementations arepossible.

[0094] The data flow begins, for example, with search criteria. Thesearch criteria may be input, for example, by a user. The searchcriteria include such information as a date range 100, a school and/orregion identification 102, an interval identification 104, or a serviceprovider identification 106.

[0095] In step 108, the IEP services within the specified date range areidentified. The resulting data are, for example, an IEP Service detailfor services in the specified date range.

[0096] In one implementation, the user may input either a schoolidentification or a region identification, but not both. In thisimplementation, in step 110, it is determined whether the user inputincludes a school identification. If the user input includes a schoolidentification, in step 112, the resulting data are searched for thespecified school identification. If the user input does not include aschool identification, in step 114, the resulting data are searched forthe specified region identification. The resulting data are now, forexample, an IEP Service detail for services in the specified date rangewith the specified school or region identification.

[0097] In step 116, the resulting data are searched for the specifiedinterval. The resulting data are now, for example, an IEP Service detailfor services in the specified date range with the specified school orregion identification for the specified interval.

[0098] In step 118, it is determined whether the user input includes aprovider identification. If the user input includes a provideridentification, in step 120, the resulting data are searched for thespecified provider identification. The resulting data are now, forexample, an IEP Service detail for services by the specified school orregion for the specified interval, with the specified provider.

[0099] In step 122, the encounter details for the resulting data areidentified. The resulting data are now, for example, an IEP Servicedetail for services actually provided in the specified date range withthe specified school or region identification for the specifiedinterval, with the specified provider.

[0100] The resulting data from step 120 contains all of the IEP servicesthat were supposed to be provided for the specified data range, schoolor region, interval, and provider. The resulting data from step 122contains all of the IEP services that were actually provided for thespecified data range, school or region, interval, and provider. Theresulting data from step 120 are compared to the resulting data fromstep 122 to determine which expected services were actually provided. Areport is generated detailing which expected services were actuallyprovided. The report includes, for example, the percentage of under- orover-serviced children. The report also includes, for example, thenumber of required, met, attempted, missed, made up, or missingservices.

[0101]FIG. 12 is a flow diagram illustrating data flow for encountertracker reporting and gap analysis functions, in accordance with anembodiment of the present invention. FIG. 12 illustrates one possibleimplementation of a method to extract encounter data. The method of FIG.12 can be implemented, for example, as one or more SQL queries made to adatabase. Other implementations are possible.

[0102] The data flow begins, for example, with a user inputting searchcriteria. The search criteria input by the user include such informationas a date range 200 and a provider identification 202.

[0103] In step 204, the service provider is identified. The resultingdata now include, for example, data identifying the service provider.

[0104] In step 206, the IEPs for the service provider are identified.The resulting data now include, for example, data identifying theservice provider and the IEPs serviced by the service provider.

[0105] In step 208, the students that these IEPs are meant for areidentified. The resulting data now include, for example, dataidentifying the students who were supposed to receive any services fromthe provider during the specified date range.

[0106] In step 210, all IEPs for these students are identified. Thisincludes IEPs that become valid at a future date. The resulting data nowinclude, for example, all services that these students are supposed toreceive.

[0107] In step 212, the service providers for the IEPs are identified.The resulting data now include, for example, all service providers whowill provide services for these students.

[0108] In step 214, the encounters for the iEPs are identified. Theresulting data now include, for example, actual instances of servicesprovided to students.

[0109] The final output data contains all of the IEP services that werereceived by students serviced by the specified provider. This alsoincludes services provided by other service providers. The final outputdata may also contain spurious records that should not be counted asservices provided. However, the spurious records can be used to identifythe IEP that is valid on a given date.

[0110]FIG. 13 is a flow diagram illustrating data flow for furtherencounter tracker functions, in accordance with an embodiment of thepresent invention. The method of FIG. 13 counts the services providedfor a particular IEP by a particular provider in a given date range. Inone embodiment, a report of services provided is output.

[0111] The method begins in step 300 when SQL results are received,determined, or otherwise provided. The SQL results are, for example,data results of the method of FIG. 11 or of FIG. 12. In implementations,the SQL results are sorted, such that, for example, all records for agiven IEP are received one after the other.

[0112] In step 302, an IEP record is read and information is stored. Thestored information includes, for example, IEP, student, serviceprovider, school, and service information. The stored information isused to compare this record to subsequent records, in order to calculatetotal services provided for a given IEP. In step 304, it is determinedwhether the main or specified service provider is the same as the IEPdetails service provider, or the provider that was expected to providethe services.

[0113] If It Is determined that the main provider is the same as the IEPdetails service provider, in step 306, it is determined whether the IEPis valid for the specified date range.

[0114] If it is determined that the IEP is valid for the specified daterange, in step 308, the details of the expected and provided servicesare read. The number of services provided for the services provided orattempted are then added to the totals counter.

[0115] In step 310, the next record is read. It is then determinedwhether the record is for the same IEP detail and in the same reportingtime period. If the record is for the same IEP detail and for the samereporting time period, the method returns to step 308. If there are nomore records to be read in step 310, the process ends in step 312.

[0116] If it is determined in step 304 that the main service provider isnot the same as the IEP details service provider, the next record isread in step 314. Thus the services provided by a service provider otherthan the main service provider are not included in the totals counter.

[0117] In step 316, it is determined whether the IEP of the new recordis different from the IEP for the old record. This includes, forexample, comparing data stored in step 302 to data for the new record.If the IEP of the new record is not different from the IEP for the oldrecord, the method continues in step 304.

[0118] If the IEP of the new record is different from the IEP for theold record, in step 318, it is determined whether the new record is forthe same student/provider/school/service combination. This includes, forexample, comparing data stored in step 302 to data for the new record.If the data for the new record is the same as the data for the oldrecord, the method continues in step 304.

[0119] If the data for the new record is the different from the data forthe old record, the method returns to step 302, wherein information forthe new record is stored.

[0120] If it is determined in step 320 that the new record does not havethe same IEP detail or is not in the same reporting period as the lastrecord, the IEP details for the given time period are printed orwritten, for example, to a report in step 322. The totals counter isthen reset in step 324, and the method then returns to step 316.

[0121] FIGS. 14-18 illustrate sample screens that are displayed to auser running a report on the number of encounters provided. In oneembodiment of the present invention, the screens displayed to a userdepend, however, on the role assigned to the user or on userpermissions. For example, upon first executing an application inaccordance with the present invention, a service provider may bepresented with an individualized caseload; however, the service providermay not have permission to change the IEPs in the system.

[0122]FIG. 14 is an example GUI screen shot for encounter trackerfunctions, in accordance with an embodiment of the present invention.This GUI screen shot is displayed to a user, for example, upon login.The user selects “Report” to activate the reporting functionality.

[0123] In FIG. 15, the presented screen shot is displayed, for example,after a user selects “Report” from the GUI of FIG. 14. The user selects“Encounter Tracking” to activate the encounter tracking functionality.

[0124] In FIG. 16, the presented screen shot is displayed, for example,after a user selects “Encounter Tracking” from the GUI of FIG. 15. Theuser selects “Service Provider's Summary (For All Students)” and entersinformation to activate the service provider summary functionality. Theinformation entered by the user includes, for example, school orarea/district data, interval data, data range data, and optional serviceprovider data. The also selects either “Print” or “Preview” to print orpreview the report.

[0125] In FIG. 17, the shown GUI is displayed, for example, if there areno data for the search criteria entered by the user in the GUI of FIG.16.

[0126] FIGS. 18A-B are example GUI screen shots that are displayed aftera user selects “Preview” from the GUI of FIG. 16. The data shown in thereport includes, for example, student personal identification number,student database identification, student date of birth, student firstname, student last name, service provider first name, service providerlast name, number of sessions per interval for service, date of sessionencounter, total of all sessions for time period, school identification,school name, grade, nature of service provided, nature of serviceprovided identification, duration of a single encounter, intervalidentification, whether the encounter was met or provided, whether theencounter was missed, whether the encounter was made up, whether thesession for an encounter was met, whether the session for the encounterwas attempted, whether the session for the encounter was missed, andwhether the session for the encounter was made up. As shown in FIG.18A-B, the report shows the calculated service gap as number of sessionsand number of hours.

[0127]FIG. 19 is a flow diagram illustrating a process for service gapanalysis, in accordance with an embodiment of the present invention. Theprocess creates a listing of specified time periods, such as months, andfor each time period, lists the number of services expected and thenumber of services delivered.

[0128] The process begins in step 1400. In step 1401, the relevantstudents are identified. In step 1402, all IEPs for all relevantstudents are identified. In step 1404, the correct start and end datesfor these IEPs are determined. In step 1406, the valid dates for the IEPdetails are determined based on the correct start and end dates.

[0129] In step 1408, the time periods to be processed are identified.The time periods to be processed are the time periods for which aservice gap analysis is to be generated. This information may be inputby a user, or may be identified automatically by a system. For example,a system could automatically identify the current month.

[0130] In step 1410, the valid details based on the months to beprocessed are identified. The valid details are the details thatoccurred during a valid date for an IEP, as determined in step 1406; andalso occurred during a time period to be processed, as identified instep 1408.

[0131] In step 1412, the encounters that happened after the IEPsterminated are identified. In step 1414, the results of step 1410 and1412 are used to build a complete list of all time periods during whichservices were expected, the number of services expected, and the numberof services delivered.

[0132] One embodiment of the present invention provides functionality toconvert prescribed and delivered services to a common base. For example,prescribed and delivered services can be converted to and expressed inminutes per week, hours per month, or any other appropriate form. Thisfunctionality enables comparison of prescribed and delivered services.

[0133]FIG. 20 is a representative diagram illustrating a system 1500 forencounter tracking and service gap analysis, in accordance with anembodiment of the present invention. The system includes a core unit1502 such as a PC, minicomputer. mainframe computer, microcomputer,telephonic device, or wireless device, such as a hand-held wirelessdevice. The core unit 1502 has a processor and a repository for data ora connection to a repository for data. The core unit 1502 may beconnected to a network, such as the Internet or an intranet, viacouplings. The couplings include, for example, wired, wireless, orfiberoptic links. In another embodiment, the method and system of thepresent invention operate in a stand-alone environment, such as on asingle terminal.

[0134] The system 1500 also includes a storage system 1504, such as adatabase, text file, or other electronic storage system. The storagesystem 1504 is located, for example, within the core unit 1502.

[0135] The system 1500 also includes an application 1506. Theapplication is located, for example, on the core unit 1502. Theapplication 1506 is implemented, for example, as machine-readable andmachine executable instructions. These instructions are executed, forexample, on the core unit 1502. The application includes functionalityfor encounter tracking, service gap analysis, and reimbursement.

[0136] A user 1508 may interact with the application 1506 via an inputdevice on the core unit 1502, such as, for example, a keyboard, a mouse,or another input device. In response to the input from the user, theapplication 1506 may access information in the storage unit 1504 and maygenerate output to display to the user 1508 via a display device, suchas a monitor or printer, located in or in communication with the coreunit 1502. The user may also input, delete, or edit information in thestorage unit 1504 via the application 1506.

[0137] An external application 1510, such as SETS or Encore, may existon the core unit 1502 and may interact with the user and the database aswell. The external application identifies service providers, providesfor customizable scheduling, and provides other features. Actionsperformed using the external application may impact the informationstored in the storage unit 1504. In one implementation, however, ratherthan being a separate application, the external application isintegrated with the application 1506.

[0138] FIGS. 21-23 illustrate sample GUI screens that are displayed to auser when a user performs a service gap analysis report.

[0139]FIG. 21 is an example GUI screen shot that is displayed after auser executes the application. FIG. 21 contains three buttons presentinga user with the following 3 options: Report Option, Config, Quit. Theuser selects “Report Option” to activate the service gap reportingfunctionality.

[0140]FIG. 22 is an example GUI screen shot for service gap analysisthat is displayed after a user selects “Report Option” from the GUI ofFIG. 21. The user selects a type of report. For example, the user mayselect a report based on a date range; a service provider and daterange; a service provider, school, and date range; a school and daterange, a type of service and date range; or a type of service school,and date range. The user also selects either “View Report,” which allowsthe user to view, print, and email the report, “Onscreen Report” viewthe report onscreen, or “Quit” to exit from the system.

[0141]FIG. 23 is an example GUI screen shot for service gap analysisthat is displayed after a user selects a Date Range Report and selects“Onscreen Report” from the GUI of FIG. 22. The data displayed in thereport is sorted, for example, by student, and includes, for example,the months or other time periods in the specified date range, the numberof expected services, the number of actual services provided, and theshortfall or excess, or difference between expected services and actualservices, cumulative shortfall (including shortfall outside thespecified date range), the number of expected encounters, the number ofactual encounters or sessions provided, the shortfall or excess ofencounters or sessions, and the cumulative shortfall of encounters orsessions.

[0142] Example embodiments of the present invention have now beendescribed in accordance with the above advantages. It will beappreciated that these examples are merely illustrative of theinvention. Many variations and modifications will be apparent to thoseskilled in the art. For example, while systems have been described interms of one machine, the invention may be practiced in a distributednetworking environment such as, for example, a Local-Area Network (LAN),Virtual Private Network (VPN), intranet, or the Internet.

1. A method for service gap analysis, the method comprising: receiving adate range; identifying at least one service plan that is valid withinthe date range; determining the expected number of services within thetime period; and identifying at least one encounter associated with theservice plan occurring within the date range.
 2. The method of claim 1,wherein the service plan is an individual education plan used incomplying with the Individuals with Disabilities Education Act.
 3. Themethod of claim 1, further comprising: for each service plan, comparingthe expected number of services with the number of identified encountersfor the service plan.
 4. The method of claim 3, wherein a result isproduced for each service plan, the result includes a number indicatingthe shortfall or surplus of encounters for the service plan.
 5. Themethod of claim 1, further comprising: comparing the expected number ofservices for all identified service plans with the number of identifiedencounters for all identified service plans.
 6. The method of claim 5,wherein a result is produced for identified service plans, the resultincludes a number indicating the shortfall or surplus of encounters forall identified service plans.
 7. The method of claim 1, wherein the daterange is divided into at least one time period.
 8. The method of claim7, further comprising for each time period and each service plan,comparing the expected number of services within the time period withthe number of identified encounters for the service plan within the timeperiod.
 9. The method of claim 8, wherein a result is produced for eachtime period and each service plan, the result including a numberindicating the shortfall or surplus of encounters for the service planwithin the time period.
 10. The method of claim 7, further comprising:for each time period, comparing the expected number of services for allidentified service plans with the number of identified encounters forall identified service plans.
 11. The method of claim 10, wherein aresult is produced for all identified service plans for each timeperiod, the result including a number indicating the shortfall orsurplus of encounters for all identified service plans within the timeperiod.
 12. The method of claim 1, wherein the at least one identifiedencounter for a service plan includes each encounter that occurred afterthe service plan terminated.
 13. The method of claim 1, wherein each ofthe at least one identified encounter is associated with a service thatwas provided or attempted.
 14. A method for entering encounterinformation into a storage system, the method comprising: receivinginformation describing a service encounter, the received informationincluding an encounter type and the duration of the encounter; andstoring information describing the service encounter, the storedinformation including the encounter type and the duration of theencounter; wherein the stored information is associated with a serviceplan, an individual receiving the service, and a service provider. 15.The method of claim 14, wherein the received information furtherincludes a service plan, an individual receiving the service, and aservice provider.
 16. The method of claim 14, wherein the storedinformation further includes a service plan, an individual receiving theservice, and a service provider.
 17. The method of claim 14, wherein theencounter type specifies one selected from a group consisting ofservices provided, attempted services, and missed services.
 18. Themethod of claim 14, wherein the stored information further includes aresult of the encounter
 19. A system for assisting a management entitywith compliance with a management scheme, the management schemeincluding a plurality of requirements, the system comprising: means forreceiving a date range; means for identifying one or more service plansthat are valid within the date range; means for determining the expectednumber of services within the date range; and means for identifying atleast one encounter associated with the service plan occurring withinthe date range.
 20. A system for assisting a management entity withcompliance with a service plan, the management scheme including aplurality of requirements, the system comprising: a processor; a userinterface functioning via the processor; and a repository accessible bythe processor; wherein a date range is received via the user interfaceand stored in the repository; wherein at least one service plan that isvalid within the date range is identified via the processor; wherein theexpected number of services within the time period is determined via theprocessor; and wherein, one or more encounters associated with theservice plan occurring within the date range is identified via theprocessor.
 21. The system of claim 20, wherein the processor is housedon a terminal.
 22. The system of claim 21, wherein the terminal isselected from a group consisting of a personal computer, a minicomputer,a main frame computer, a microcomputer, a hand held device, and atelephonic device.
 23. The system of claim 20, wherein the processor ishoused on a server.
 24. The system of claim 23, wherein the server isselected from a group consisting of a personal computer, a minicomputer,a microcomputer, and a main frame computer.
 25. The system of claim 23,wherein the server is coupled to a network.
 26. The system of claim 25,wherein the network is the Internet.
 27. The system of claim 25, whereinthe server is coupled to the network via a coupling.
 28. The system ofclaim 27, wherein the coupling is selected from a group consisting of awired connection, a wireless connection, and a fiberoptic connection.29. The system of claim 20, wherein the repository is housed on aserver.
 30. The system of claim 29, wherein the server is coupled to anetwork.
 31. A computer program product comprising a computer usablemedium having control logic stored therein for causing a computer to runa service gap analysis, the control logic comprising: first computerreadable program code means identifying at least one service plan thatis valid within the date range; second computer readable program codemeans for determining the expected number of services within the timeperiod; and third computer readable program code means for identifyingat least one encounter associated with the service plan occurring withinthe date range.